Alternate Delivery Platforms and Implementation Models for Bringing Evidence-Based Behavioral Interventions to Scale for Youth Facing Adversity: A Case Study in West Africa

Abstract Background: Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone. Methods: A case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth employment/entrepreneurship programs (EPP) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, eight weeks of supervision notes, and 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery strategy. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform. Results: Extant data indicate the strong feasibility and acceptability of integrating the Youth Readiness Intervention into the EPP. Facilitators of integration of the YRI into the EPP include: mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions and EPPs, and challenges in flexibility between donors and implementation partners operating in a fragile/post conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI. Conclusions: Youth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions (EBIs) to youth in fragile and post-conflict settings. Quality improvement and sustainment of EBIs are novel concepts in such settings. The CTA strategy institutionalizes the integration of an EBI into youth employment and entrepreneurship programs. Trial Registration: NCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).